IN juvenile arthritis, parent and physician global assessment discordance tracked with higher pain and catastrophizing scores.
Global Assessment Discordance In Juvenile Arthritis
A prospective observational study examined why physicians, patients, and caregivers may rate disease state differently in juvenile idiopathic arthritis. Researchers invited children with newly confirmed or suspected juvenile idiopathic arthritis, and their accompanying parents, across eight centers in Finland between November 2021 and March 2024.
Children older than 8 years and all parents completed pain and global assessments of wellbeing at baseline and at 3 months. Pain coping strategies were assessed at 3 months using a pain coping scale. Discordance between a patient or parent global assessment and the physician global assessment of disease activity was calculated by subtracting the physician score from the patient or parent score. The investigators then used a multivariable linear model to evaluate factors associated with greater discordance.
Pain And Coping Strategies Linked To Discordance
Overall, 186 families participated. A positive or negative discordance of 30 mm or greater was observed in 17% of children and 11% of caregivers.
In analyses focused on child reported discordance, lower active joint count was associated with greater discordance between patient and physician global assessments, alongside higher pain assessment scores. In other words, discordance increased as active joint count decreased and as pain ratings increased.
For caregiver reported discordance, similar patterns were reported. Lower active joint count and higher parent proxy pain assessment were each associated with greater discordance between parent and physician global assessment. In addition, higher catastrophizing scores were linked to increased discordance in parents.
Study Conclusion
The authors concluded that discordance between parent and physician global assessment was greater among parents who used catastrophizing as a pain coping strategy, highlighting a psychological correlate of disagreement beyond measured joint activity in this cohort.
Reference: Backström M et al. Parent and Physician Global Assessment Discordance in Juvenile Arthritis: The Role of Pain Coping Strategies. J Pediatr Clin Pract. 2025;18:200186.
